Jang Hyun Lee

Risk Factors of Treatment Failure in Diabetic Foot Ulcer Patients

Background Some diabetic feet heal without complication, but others undergo amputation due to progressive wounds. This study investigates the risk factors for amputation of diabetic feet. Methods A total of 55 patients who visited our institution from 2008 to 2012 were included in the study. The patients with abnormal fasting blood sugar levels, lower leg vascularity, and poor nutrition were excluded from the study group, and the wound states were unified. The patients were categorized into a treatment success group (n=47) and a treatment failure group (n=8), and their hemoglobin A1C (HgA1C), C-reactive protein (CRP), white blood cell count (WBC), and serum creatinine levels were analyzed. Results The initial CRP, WBC, and serum creatinine levels in the treatment failure group were significantly higher than that of the treatment success group, and the initial HgA1C level was significantly higher in the treatment success group. The CRP and WBC levels of both groups changed significantly as time passed, but their serum creatinine levels did not. Conclusions The initial CRP, WBC, and serum creatinine levels were considered to be risk factors for amputation. Among them, the serum creatinine level was found to be the most important predictive risk factor. Because serum creatinine represents the renal function, thorough care is needed for the feet of diabetic patients with renal impairment.

Management of delayed infection after insertion of bioresorbable plates at the infraorbital rim.

Delayed infections after use of absorbable plates in the infraorbital region have been documented in various reports. We report 2 cases of infections at the infraorbital rim after fixation with absorbable plates: one was managed with surgical removal and one was managed with conservative treatment. We recommend that, before treatment, computed tomographic scans and cultures be obtained whenever possible. The presence of maxillary sinusitis is the single most important factor in choosing surgical removal of the plates, but the patient should be fully informed about the possibility of postoperative ectropion.

Archives of Plastic Surgery Indexed in PubMed, PubMed Central and Scopus, and on the Road to Becoming an SCI(E) Journal

The Korean Society of Plastic and Reconstructive Surgeons, with over 2,000 members, is the third largest society of its kind, following those of the United States and Brazil. Based on this foundation, advances in surgical techniques have promoted the international status of Korean plastic surgery, which has led Korean plastic surgeons to actively participate in international conferences and volunteer work worldwide. Archives of Plastic Surgery (APS) is the official journal of the Korean Society of Plastic and Reconstructive Surgeons. Our journal has been published since the year 1974, with 179 issues through the year 2011, written fully in Korean, which led to difficulties in accessibility of the journal to international readers [1]. In 2012, the journal converted to a fully English form, with the new English title Archives of Plastic Surgery. Along with this transition, the journal was converted to open access, allowing readers to view or download the full text of all journal content without a subscription. For convenient online search of APS articles, the journal is indexed in representative databases such as PubMed, PubMed Central (PMC), Scopus, and Google Scholar. The strong intellectual and institutional value of the journal can be inferred from the fact that the journal was indexed in PMC and Scopus only a few months after its conversion to English. For APS to continue to increase its respectability, the next step would be to be indexed as an Science Citation Index Expanded (SCI[E]) journal. It is uncommon for journals dedicated to plastic surgery to be indexed in SCI(E). There are only 10 such plastic surgery journals worldwide: seven in the United States and one each in the UK, Canada, and Sweden. Notably, there are none in the Asia-Pacific region so far. There are cultural differences in plastic surgical practice, and when a plastic surgeon of the Asia-Pacific region submits a journal on new surgical concepts or technical approaches conforming to regional, geographical and cultural practices to the present SCI(E) journals, a lack of understanding of these underlying factors may lead to rejection of an otherwise excellent article. If APS attains SCI(E) status, it could provide a particularly valuable forum for the publication of articles on patients of different ethnic backgrounds from throughout the Asia-Pacific region, and could earn the status of the leading plastic surgery journal in this region. To be indexed as an SCI(E) journal, the impact factor (IF) is of utmost importance. In general, journals dedicated to plastic surgery do not have high impact factors. Of the 10 SCI(E) journals in this field, Plastic and Reconstructive Surgery has the highest IF of 3.382 (2011), five of the journals have their IF in the 1s, and the remaining four journals have an IF below 1. The Journal of the Korean Society of Plastic and Reconstructive Surgeons, the former body of APS, has a calculated IF of 0.072 for the year 2011 (Table 1). Taking in to account that this was a journal in the Korean language with no open access, the new IF of the APS to be calculated in the year 2014 may be safely be predicted to be higher. To perform as the leading journal of the Asia-Pacific region, publishing as a co-official journal with the societies of other Asian countries is being planned, and given the Republic of Koreas status as an IT powerhouse, development of iPad and Android applications for the journal is also underway. The APS is making multilateral efforts to earn SCI(E) status, to become an internationally renowned journal, and to lead the plastic surgery profession of the Asia-Pacific region. Table 1 The SIC(E) journals related to plastic surgery along with Archives of Plastic Surgery

Modified Functional Superficial Parotidectomy With Ligation of the Major Branch of the Parotid Duct Extending to the Superficial Lobe

Abstract A functional superficial parotidectomy can maintain salivary function by preserving the Stensen duct. However, this technique still brings the possibility of salivary leakage, because major branches of the parotid duct from the resected site do not get ligated. To reduce this complication, this study introduces a modified technique with major branch ligation. From December 2008 to February 2015, 14 patients who underwent superficial parotidectomy were divided into 2 groups. Group A was treated with the modified functional superficial parotidectomy involving the major branch between the superficial lobe and parotid duct. Group B was treated with the conventional superficial parotidectomy without involving the major branch of the parotid duct. The clinical complications, period of Hemovac usage, and surgical duration were noted in each group. Two of 8 patients in group A had a major branch from Stensen duct that was ligated, and there was no evidence of salivary leakage or sialocele in any of the patients of group A, whereas group B contained 2 cases of salivary leakage, one of which became sialocele. Group A had a significantly longer Hemovac maintenance period than group B (P < 0.05), and the duration of surgery was also significantly different between the 2 groups (P < 0.05). Because a solitary major branch of the main parotid duct occasionally extends toward the superficial lobe, our modified technique—functional superficial parotidectomy with ligation of the major branch toward the superficial lobe—is a useful option for treatment of a benign parotid mass in such cases.

Wire or Hook Traction for Reducing Zygomatic Fracture

Background Variable methods have been introduced for reduction of the zygomatic fractures. The Dingman elevator is used widely to reduce these fractures but is inappropriate in certain types of fractures which require atypical traction vectors. We introduce and examine an alternate method of reducing zygomatic fractures using wire and hook traction. Methods A retrospective study was performed for all zygomatic fracture patients admitted between 2008 and 2014. Medially rotated fractures were reduced by using a wire looped through an intermaxillary screw secured on the medial side of the zygoma. Laterally rotated fractures were reduced using a hook introduced through an infrazygomatic skin incision. Results No accidental bleeding or incomplete reduction was observed in any of the cases. Postoperative imaging demonstrated proper reduction immediately after the operation. Follow-up computed tomography study at 1 month after operation also demonstrated proper reduction and healthy union across the previous site of fracture. Conclusion The hook and wire method allowed precise application of traction forces across zygomatic fractures. The fractured bone fragment could be pulled in the direction precisely opposite to the vector of impact at the time of trauma. Soft tissue damage due to dissection was minimized. In particular, this method was effective in reducing rotated bone fragments and can be an alternative option to using the zygoma elevator.

Surgical Management of Localized Scleroderma

Background Localized scleroderma is characterized by a thickening of the skin from excessive collagen deposits. It is not a fatal disease, but quality of life can be adversely affected due to changes in skin appearance, joint contractures, and, rarely, serious deformities of the face and extremities. We present six cases of localized scleroderma in face from our surgical practice. Methods We reviewed six localized scleroderma cases that were initially treated with medication and then received follow-up surgery between April 2003 and February 2015. Six patients had facial lesions. These cases presented with linear dermal sclerosis on the forehead, oval subcutaneous and dermal depression in the cheek. Results En coup de sabre (n=4), and oval-shaped lesion of the face (n=2) were successfully treated. Surgical methods included resection with or without Z-plasty (n=3), fat graft (n=1), dermofat graft (n=1), and adipofascial free flap (n=1). Deformities of the affected parts were surgically corrected without reoccurrence. Conclusion We retrospectively reviewed six cases of localized scleroderma that were successfully treated with surgery. And we propose an algorithm for selecting the best surgical approach for individual localized scleroderma cases. Although our cases were limited in number and long-term follow-up will be necessary, we suggest that surgical management should be considered as an option for treating scleroderma patients.

Absorbable Plate-Related Infection after Facial Bone Fracture Reduction

Absorbable plates are used widely for fixation of facial bone fractures. Compared to conventional titanium plating systems, absorbable plates have many favorable traits. They are not palpable after plate absorption, which obviates the need for plate removal. Absorbable plate-related infections are relatively uncommon at less than 5% of patients undergoing fixation of facial bone fractures. The plates are made from a mixture of poly-L-lactic acid and poly-DL-lactic acid or poly-DL-lactic acid and polyglycolic acid, and the ratio of these biodegradable polymers is used to control the longevity of the plates. Degradation rate of absorbable plate is closely related to the chance of infection. Low degradation is associated with increased accumulation of plate debris, which in turn can increase the chance of infection. Predisposing factors for absorbable plate-related infection include the presence of maxillary sinusitis, plate proximity to incision site, and use of tobacco and significant amount of alcohol. Using short screws in fixating maxillary fracture accompanied maxillary sinusitis will increase the rate of infection. Avoiding fixating plates near the incision site will also minimize infection. Close observation until complete absorption of the plate is crucial, especially those who are smokers or heavy alcoholics. The management of plate infection is varied depending on the clinical situation. Severe infections require plate removal. Wound culture and radiologic exam are essential in treatment planning.